Abstract
BackgroundLong-term regular clinic follow up is an important component of HIV care. We determined the frequency and characteristics of HIV-infected patients lost to follow up from a London HIV clinic, and factors associated with loss to all HIV follow up in the UK.MethodsWe identified 1859 HIV-infected adults who had registered and attended a London clinic on one or more occasions between January 1997 and December 2005. Loss to follow up was defined as clinic non-attendance for one or more years. Through anonymized linkage with the Survey of Prevalent HIV Infections Diagnosed and Health Protection Scotland, national databases of all HIV patients in care in the UK up to December 2006, loss-to-follow-up patients were categorized as Transfers (subsequently received care at another UK HIV clinic) or UKLFU (no record of subsequent attendance at any HIV clinic in the UK). Logistic regression analysis was used to identify factors associated with UKLFU for those both on highly active antiretroviral therapy (HAART) and not on HAART.ResultsIn total, 722 (38.8%) of 1859 patients were defined as lost to follow up. Of these, 347 (48.1%) were Transfers and 375 (51.9%), or 20.2% of all patients, were UKLFU. Overall, 11.9% of all patients receiving HAART, and 32.2% not receiving HAART were UKLFU. Among those on HAART, risk factors for UKLFU were: African heterosexual female (OR = 2.22, 95% CI: 1.11-4.56) versus white men who have sex with men; earlier year of HIV clinic registration (1997-1999 OR: 3.51, 95% CI: 1.97-6.26; 2000-02 OR: 2.49, 95% CI: 1.43-4.32 vs. 2003-2005); CD4 count of < 200 versus > 350 cells/mm3 (OR = 1.99, 95% CI:1.05-3.74); and a detectable viral load of > 400 copies/ml (OR = 5.03, 95% CI: 2.95-8.57 vs. ≤ 400 copies/ml) at last clinic visit.Among those not receiving HAART, factors were: African heterosexual male (OR = 3.91, 95% CI: 1.77-8.64) versus white men who have sex with men; earlier HIV clinic registration (2000-2002 OR: 2.91, 95% CI: 1.77-4.78; 1997-1999: OR: 5.26, 95% CI: 2.71-10.19); and a CD4 count of < 200 cells/mm3 (OR: 3.24, 95% CI: 1.49-7.04).ConclusionsOne in five HIV-infected patients (one in three not on HAART and one in nine on HAART) from a London clinic were lost to all clinical follow up in the UK. Black African ethnicity, earlier year of clinic registration and advanced immunological suppression were the most important predictors of UKLFU. There is a need for all HIV clinics to establish systems for monitoring and tracing loss-to-follow-up patients, and to implement strategies for improving retention in care.
Highlights
Long-term regular clinic follow up is an important component of HIV care
762 (40.1%) had been prescribed highly active antiretroviral therapy (HAART) within six months of their last clinic visit. Those prescribed HAART within six months of their last clinic visit were more likely to be white than those who had not received HAART, even after adjustment for CD4 count, but there was no significant difference in gender or risk group
Factors associated with lost to follow up (LFU) among those receiving or not receiving HAART Overall, in a multivariate analysis, the factors most strongly associated with the UKLFU group versus the clinical attendees (CCAs) group were: not receiving HAART versus current HAART use (OR = 2.14, 95% CI: 1.14 to 3.27); being a black African heterosexual man (OR = 1.91, 95% CI: 1.08 to 3.35) or black African heterosexual woman (OR = 1.93, 95% CI: 1.18 to 3.15) versus white men who have sex with men (MSM); earlier clinic
Summary
Long-term regular clinic follow up is an important component of HIV care. We determined the frequency and characteristics of HIV-infected patients lost to follow up from a London HIV clinic, and factors associated with loss to all HIV follow up in the UK. There have been several studies on losses to follow up from HAART programmes across sub-Saharan Africa [16,17,18,19,20], until recently there had been a paucity of information on losses to follow up from HIV care in high-income countries [21,22,23,24,25,26] Most of these studies were conducted prior to the widespread use of HAART [23,25,26] or in research cohorts [27,28,29]. Since many clinics do not have established systems for identifying patients who are lost to follow up (LFU), there is need for a greater understanding of the rates and reasons for loss to follow up to develop strategies to optimize retention
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